Congenital Torticollis

This hard-to-pronounce newborn condition sounds pretty frightening — especially once you consider its Latin meaning ("twisted neck") — but in reality, torticollis isn't as scary as it sounds.

Babies born with congenital torticollis have limited mobility in their necks, causing their heads to tilt to one side. But with treatment — stretching and strengthening exercises, for instance — most infants with congenital torticollis regain full head and neck mobility within months.

What is congenital torticollis?

One in every 300 babies is born with or develops congenital torticollis within their first three months of life. A baby with torticollis has a misaligned neck, which in turn causes her head to tip to one side and her chin to point in the opposite direction. Even though it may look uncomfortable, fortunately the condition isn’t painful for little ones.

What causes congenital torticollis?

Congenital torticollis is most often caused when the muscle that runs along both sides of the neck (the sternocleidomastoid muscle, or SCM for short) is strained, causing it to contract and shorten. This tightening might happen if your baby is in a cramped or unusual position in the womb (such as breech); but not all breech or cramped babies are born with the condition, and it’s not always clear why some babies are born with torticollis and others are not. The use of forceps and/or a vacuum during delivery may also be a factor related to torticollis. In very rare cases, congenital torticollis may be caused by an underlying condition such as a spinal abnormality, dwarfism, or a bone-growth disorder.

Who is at risk for congenital torticollis?

Since this condition is commonly caused by a cramped fetal position, larger babies or twins sharing space in utero may be at higher risk for developing torticollis. The condition affects boys and girls equally.

What are the symptoms of congenital torticollis?

If your baby’s head seems to always be tilted to one side or if she can’t seem to follow your face as you move from one side of her body to the other, she may be having difficulty moving her neck. If your baby has torticollis you may also notice a small, harmless lump on the side of her neck in the area of the damaged SCM muscle. Don’t worry, the lump — an inflammation of the muscle — will typically resolve on its own before your baby turns two years old.) Many more infants with congenital torticollis — up to 90 percent — have an asymmetrical head shape, called plagiocephaly; it may look like the side or back of your baby’s head is flatter than the rest. Some affected babies also have slightly asymmetrical facial features — but with treatment, both plagiocephaly and facial asymmetry will typically resolve.

How is congenital torticollis diagnosed and treated?

Babies are usually diagnosed within the first six-to-eight weeks of life. A pediatrician will examine your infant’s neck and may order X-rays if torticollis is suspected. If your doctor determines your baby has torticollis, it’s important to start treatment right away to prevent permanent facial asymmetry, a flat spot on your baby’s head, and restricted head movement. Your doctor may show you some gentle stretching exercises to help loosen your baby’s tight neck muscles. You may also be referred to a physical therapist, who will continue stretching and strengthening exercises with your infant on a regular basis. Both the doctor and physical therapist will encourage you to give your baby plenty of tummy time to help build up those neck muscles. Continue strengthening those muscles by motivating your little one to turn her head to the side she normally doesn't turn to: Place her in the crib on her back with her face to the wall in an attempt to get her to roll her head to the opposite direction to see the view of the room or the noisy, brightly colored toy you’re shaking on her “blind” side. Also put her to sleep on her back with her head positioned in the opposite direction of the tilt.

For severe cases that don’t improve within a year, your doctor may consider a muscle-release surgery (performed by an orthopedic surgeon) to restore your baby’s full range of head and neck movement.

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect the First Year. Health information on this site is based on peer-reviewed medical journals and highly respected health organizations and institutions including ACOG (American College of Obstetricians and Gynecologists), CDC (Centers for Disease Control and Prevention) and AAP (American Academy of Pediatrics), as well as the What to Expect books by Heidi Murkoff.